1. About psychosis

Women and Psychosis: A Guide for Women and Their Families

On this page:

What is psychosis?
Do women and men experience psychosis differently?
Illnesses with psychotic symptoms
Diagnosis

What is psychosis?

The term “psychosis” refers to a state of mind during which thinking, reasoning and mood are disrupted in major ways.

Many factors can play a role in the onset of psychosis, including high fever, a drug reaction, neurological illness (an illness of the brain, such as epilepsy), and family history of psychosis. Often the cause is unknown, and the illness appears to come “out of the blue.”

During a period of psychosis, a woman may be convinced that her partner is cheating on her, even if this is not true. She may read meaning into her partner’s gestures, tone and actions that are based on her worst fears, not on reality. A woman having a psychotic episode may hear a voice in her head confirming her fears, which she takes as proof that her beliefs are true. It is difficult to change such fixed beliefs, even though there is evidence that contradicts them.

Sometimes psychotic convictions (called delusions) stem from a mood disruption. If a woman is very depressed, for example, she may feel unlovable; this may lead her to believe (falsely) that she is being abandoned, discriminated against or attacked. This also happens to men. Typically, women’s delusions focus on relationships; the false belief that a partner is cheating on her is a common delusion in women experiencing psychosis. Men’s delusions tend to involve issues such as terrorist plots, spiritual concerns and computer espionage.

Early in a psychotic episode, it is difficult to determine the underlying cause of psychotic symptoms. And symptoms change over time, making diagnosis even harder. There is no “objective” test for psychosis. The diagnosis is a clinical opinion based on:

what the woman (and her family) report
what seems to have triggered the problem
the duration of symptoms
changes in symptoms
how much the symptoms interfere with everyday function
family history.

Do women and men experience psychosis differently?

Women are as likely as men to develop psychosis. While psychosis arising from drug use is less common in women than in men, psychosis associated with mood fluctuation is more common in women than in men.

When women are diagnosed with schizophrenia, they tend to have fewer “negative” symptoms (things that are “taken away” when the person becomes ill) than men do. The negative symptoms (e.g., loss of pleasure or motivation) are often the ones on which the diagnosis of schizophrenia is made. Yet women rarely show these symptoms, making a diagnosis of schizophrenia in women more difficult. On the other hand, mood symptoms, especially depression, are common in women even when the illness turns out, in the end, to be schizophrenia rather than a depressive psychosis. Symptoms of depression include crying easily, feeling guilty and losing hope. When mood symptoms and cognitive symptoms (e.g., loss of reasoning ability) occur at the same time, accurate diagnosis is even harder.

Psychotic illnesses first affect women at a later age than men and are often triggered by events. Women tend to be vulnerable in their early twenties, and the trigger is often a relationship failure. Men tend to be vulnerable in their late teens, and the trigger may be alcohol and other drug use.

The later start to illness gives women the advantage of having more schooling behind them when they first get ill. They also have more relationship and work experience, which helps with recovery. Women generally respond better to treatments for psychosis than men do. Women seem to do well with relatively low drug doses. In general, women tend to be more open to talking about their experiences and, therefore, do better than men with psychosocial treatments. This is good news for women.

However, women go through times when the risk of relapse is high (e.g., premenstrual, childbirth and postpartum periods, and menopause). This suggests that women’s hormones may affect their resistance to psychosis. Other risk factors for women include poverty, immigration, substance use, domestic abuse, sexual exploitation and single parenthood. Thyroid drugs and steroid drugs (used more by women than by men) are also risk factors.

Illnesses with psychotic symptoms

Psychotic symptoms occur in many medical and neurological illnesses. Different types of psychosis may need specific treatment.

(For more on the following topics, see Suggested Readings)

Schizophrenia

Schizophrenia is characterized by three clusters of symptoms.

The first cluster is “positive” symptoms — symptoms that are “added on” when the person becomes ill. Positive symptoms include hallucinations (disorders of perception, e.g., hearing, seeing, tasting, smelling or feeling something that isn’t really there) and delusions (fixed beliefs not based in fact).

The second cluster is “negative” symptoms — things that are “taken away” when the person becomes ill. Negative symptoms include loss of pleasure, motivation and initiative, feeling apathetic, showing little emotion and avoiding social contact.

The third cluster is cognitive symptoms — these include loss of memory, reasoning and calculating abilities.

For a person to be diagnosed with schizophrenia, these three clusters of symptoms must have lasted for at least six months, and must interfere with the person’s ability to function. Schizophrenia is a long-lasting illness. Remissions (periods when a person has no symptoms) occur, but the person needs to continue treatment even during a remission to prevent relapse (the return of symptoms).

Schizophreniform disorder

This term is used for symptoms of schizophrenia that have not yet lasted for six months. Schizophreniform disorder may disappear on its own or may develop into a longer-lasting illness.

Bipolar disorder (manic depression)

Bipolar disorder is a mood illness that alternates between periods of depression and periods of elation. At times, both poles of this illness (depression and elation) may be accompanied by psychotic symptoms. For example, when depressed, people may hear voices in their heads putting them down. When elated, they may believe they have special powers and can do amazing things, without evidence to support these beliefs. In contrast to schizophrenia, when people are in remission from bipolar illness they can resume their lives as before.

Schizoaffective disorder

This term refers to illnesses where symptoms of both schizophrenia and mood disturbance are present. The two kinds of symptoms either appear at the same time or alternate.

Depression with psychotic features

Unipolar depression (depression without elation) can be accompanied by psychotic symptoms. Depression is much more common in women than in men.

Drug-induced psychosis

Drug use can elicit psychotic symptoms. Some of the drugs that trigger psychosis are marijuana, cocaine, LSD, amphetamines and ecstasy. Once the effects of the drugs wear off, the symptoms of psychosis will usually go away. If they do not go away, the drugs may have triggered a longer-lasting illness. Drug-induced psychosis is more common in men than in women.

Brief psychotic disorder

This term refers to psychotic symptoms that last less than a month. These short-lasting psychoses are more common in women than in men.

Delusional disorder

A delusional disorder is a long-lasting illness in which delusions (usually one elaborate delusion) are prominent, but in which there are no hallucinations. An example of an elaborate delusion is a person believing that a song she wrote has been stolen by a popular band, and that this band has made millions of dollars on the song. The person devotes her life to “setting the record straight” and, in so doing, neglects everything else in her life. A delusional disorder may not prevent normal functioning in some areas of life, but it strains relationships.

Post-traumatic stress disorder (PTSD)

This term refers to non-psychotic symptoms that follow a traumatic experience such as a violent assault. The affected person relives the event, is preoccupied with it, avoids situations associated with it and may have flashbacks (visual and auditory recollections of the event) that are impossible to distinguish from the hallucinations of a psychotic illness. More women than men develop PTSD symptoms when exposed to a traumatic event.

Diagnosis

Psychiatric diagnoses are not objective (no blood test or X-ray confirms the diagnosis). To help your doctor make an accurate diagnosis, it is important to be as thorough as possible when telling your doctor what you are experiencing. Let him or her know what you have been thinking and feeling. If you have been using alcohol or other drugs, you need to tell your doctor how much and how recently. If you have been traumatized, either as a child or as an adult, tell your doctor. You also need to discuss any family history of mental health problems openly.

It may be distressing or confusing to talk to a health care professional, especially when you are not well. The symptoms of illness may interfere with your ability to express yourself. Your doctor or other members of your health care team may ask for your consent to speak to your family or close friends. Family and friends can give information about what they have observed that may help with the diagnosis.

The more information your doctor has, the more likely he or she is to make the most accurate diagnosis.